Objective: To identify evidence-based prognostic factors in the subacute phase after stroke for activities of daily living (ADL) and ambulation at six months to one year after stroke.
Design: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, Psyclit, and Sociological Abstracts. (2) Reference lists, personal archives, and consultation of experts. (3) Guidelines.
Methods: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for ADL and ambulation; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration.
Results: From 1027 potentially relevant studies 26 studies involving a total of 7850 patients met the inclusion criteria. Incontinence for urine is the only prognostic factor identified in three studies with a level A (i.e., a good level of scientific evidence according to the methodological score). The following factors were found in one level A study: initial ADL disability and ambulation, high age, severe paresis or paralysis, impaired swallowing, ideomotor apraxia, ideational apraxia, and visuospatial construction problems; as well as factors relating to complications of an ischaemic stroke, such as extraparenchymal bleeding, cerebral oedema and size of intraparenchymal haemorrhage.
Conclusions: The present evidence concerning possible predictors in the subacute stage of stroke has insufficient quality to make an evidence-based prediction of ADL and ambulation after stroke because only one prognostic factor was demonstrated in at least two level A studies, our cut-off for sufficient scientific evidence.
References
1.
Straten A van, Meulen JHP van der, Bos GAM van den, Limburg M. Length of hospital stay and discharge delays in stroke patients. Stroke1997; 28: 137–40.
2.
Scholte op Reimer WJM. Long-term care after stroke. Studies on care utilization, quality of care and burden of caregiving (dissertation). Amsterdam. Academic Medical Center/University of Amsterdam, the Netherland; 1999.
3.
Barer DH, Mitchell JR. Predicting the outcome of acute stroke: do multivariate models help?Q J Med1989; 70: 27–39.
4.
Brosseau L, Potvin L, Philippe P, Boulanger Y. Post-stroke inpatient rehabilitation. II. Predicting discharge disposition. Am J Phys Med Rehabil1996; 75: 431–36.
5.
Colantonio A, Kasl SV, Ostfeld AM, Berkman LF. Psychosocial predictors of stroke outcomes in an elderly population. J Gerontol Social Sci1993; 48: 261–68.
6.
Geerts MJP, de Witte LP, Visser-Meily JMA, Tilli DJP, Lindeman E, Bakx WGM. Daily functioning during the first year after stroke: living arrangements and use of rehabilitation and other care facilities after discharge from hospital. J Rehabil Sci1995; 8: 39–45.
7.
Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ. Predicting disability in stroke – a critical review of the literature. Age Ageing1996; 25: 479–89.
8.
Moher D et al. Improving the quality of reports of meta-analyses of randomized controlled trials: the Quorom statement. Lancet Eprint1999; 99ART/4149: UR.
9.
Mulrow CD, Oxman AD. Cochrane collaboration handbook (updated September 1997). In: The Cochrane Library. Oxford: Update Software, 1999.
10.
Guidelines of the Netherlands Society for Neurology (1996).
11.
Guidelines Stroke 2000 of the Dutch Institute for Quality in Health Care CBO.
12.
World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: WHO, 1980.
13.
Anonymous. Symposium recommendations for methodology in stroke outcome research. Task Force on Stroke Impairment, Task Force on Stroke Disability, and Task Force on Stroke Handicap. Stroke1990; 21(9 suppl): II68–II73.
14.
Kernan WN, Feinstein AR, Brass LM. A methodological appraisal of research on prognosis after transient ischaemic attacks. Stroke1991; 22: 1108–16.
15.
Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical epidemiology, a basic science for clinical medicine, second edition. Boston: Little, Brown & Company, 1991.
16.
Barer DH. The influence of visual and tactile inattention on predictions for recovery from acute stroke. Q J Med1990; 74: 21–32.
17.
Elmstahl S, Sommer M, Hagberg B. A 3-year follow-up of stroke patients: relationships between activities of daily living and personality characteristics. Arch Gerontol Geriatr1996; 22: 233–44.
18.
Gompertz P, Pound P, Ebrahim S. Predicting stroke outcome: Guy's prognostic score in practice. J Neurol Neurosurg Psychiatry1994; 57: 932–39.
19.
Heiss WD, Emunds HG, Herholz K. Cerebral glucose metabolism as a predictor of rehabilitation after ischemic stroke. Stroke1993; 24: 1784–88.
20.
Henon H, Lebert F, Durieu I et al. Confusional state in stroke – relation to preexisting dementia, patient characteristics, and outcome. Stroke1999; 30: 773–79.
21.
Jehkonen M, Ahonen J-P, Dastidar P et al. Visual neglect as a predictor of functional outcome one year after stroke. Acta Neurol Scand2000; 101: 195–201.
22.
Jørgensen HS, Nakayama H, Raaschou HO et al. Outcome and time course of recovery in stroke. Part I: outcome. The Copenhagen Stroke Study. Arch Phys Med Rehabil1995; 76: 399–405.
23.
Jørgensen HS, Nakayama H, Raaschou HO, Pedersen PM, Houth J, Olsen TS. Functional and neurological outcome of stroke and the relation to stroke severity and type, stroke unit treatment, body temperature, age, and other risk factors: The Copenhagen Stroke Study. Top Stroke Rehabil2000; 6: 1–19.
24.
Juvela S. Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol1995; 52: 1193–200.
25.
Lampl Y, Gilad R, Eshel Y, Sarova-Pinhas I. Neurological and functional outcome in patients with supratentorial haemorrhages: a prospective study. Stroke1995; 26: 2249–53.
26.
Lin HJ, Wolf PA, Kelly-Hayes M et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke1996; 27: 1760–64.
27.
Lincoln NB, Drummond AE, Berman P. Perceptual impairment and its impact on rehabilitation outcome. SUE Study Group. Disabil Rehabil1997; 19: 231–34.
28.
Motto C, Ciccone A, Aritzu E et al. Hemorrhage after an acute ischemic stroke. Stroke1999; 30: 761–64.
29.
Mukherjee N, Hazra BR. Evaluation of stroke patients with reference to CT scan findings. J Indian Med Assoc1998; 96: 174–76.
30.
Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Orientation in the acute and chronic stroke patient: impact on ADL and social activities. The Copenhagen Stroke Study. Arch Phys Med Rehabil1996a; 77: 336–339.
31.
Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. The impact of aphasia on ADL and social activities after stroke: the Copenhagen Stroke Study. J Neurol Rehabil1996; 10: 91–96.
32.
Samuelsson M, Soderfeldt B, Olsson GB. Functional outcome in patients with lacunar infarction. Stroke1996; 27: 842–46.
33.
Sanchez-Blanco I, Ochoa-Sangrador C, Lopez-Munain L, Izquierdo S, M, Fermoso-Garcia J. Predictive model of functional independence in stroke patients admitted to a rehabilitation programme. Clin Rehabil1999; 13: 464–75.
34.
Stone SP, Patel P, Greenwood RJ. Selection of acute stroke patients for treatment of visual neglect. J Neurol Neurosurg Psychiatry1993; 56: 463–66.
35.
Sveen U, Wyller TB, Ljunggren AE, Bautz-Holter E. Predictive validity of early cognitive assessment in stroke rehabilitation. Scand J Occup Ther1996; 3: 20–27.
36.
Taub NA, Wolfe CD, Richardson E, Burney PG. Predicting the disability of first-time stroke sufferers at 1 year. 12-month follow-up of a population-based cohort in southeast England. Stroke1994; 25: 2–7.
37.
Thommessen B, Bautz-Holter E, Laake K. Predictors of outcome of rehabilitation of elderly stroke patients in a geriatric ward. Clin Rehabil1999; 13: 123–28.
38.
Wade DT, Hewer RL. Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry1987; 50: 177–82.
39.
Wyller TB, Sodring KM, Sveen U, Ljunggren AE, Bautz-Holter E. Are there gender differences in functional outcome after stroke?Clin Rehabil1997; 11: 171–79.
40.
Sveen U, Bautz-Holter E, Wyller T Bruun, Ljunggren AE. Assessment of cognitive impairments after stroke: a methodological study. Scand J Occup Ther1994; 1: 85–93.
41.
Sødring KM, Bautz-Holter E, Ljunggren AE, Wyller TB. Description and validation of a test of motor function and activities. Scand J Rehabil Med1995; 27: 211–17.
42.
Jongbloed L. Problems of methodological heterogeneity in studies predicting disability after stroke. Stroke1990; 21(9 suppl): II32–II34.
43.
Laupacis A, Wells G, Richardson WS, Tugwell P. Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. JAMA1994; 272: 234–37.
44.
Wade DT, Langton Hewer R., Wood VA. Stroke: the influence of age upon outcome. Age Ageing1984; 13: 357–67.
